What is the Indiana prompt-pay deadline for dental claims, and what interest applies to late payment?

Under Ind. Code §27-8-5.7-6; §27-13-36.2-4, the Indiana payment deadline is 30 days (electronic) and 45 days (paper). Interest accrues from day 31 (electronic) or day 46 (paper) until the claim is paid. Dental applicability: Covered on both tracks, but not because the chapter says so: the clean-claim chapter contains no definition of "provider" at all, and the word "dental" appears in it only in the permitted-forms list. A self-funded private-employer (ERISA) plan is generally beyond this statute's reach and runs on the federal claims-procedure clock instead — but that comes from the courts reading 29 U.S.C. § 1144, not from its text, and it is not categorical: a self-funded governmental or church plan is not an ERISA plan at all, § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law, and nothing in § 1144 bars a state from reaching the third-party administrator or the network contract.

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Dental expressly covered · Last verified 2026-08-31

Indiana prompt-pay law for dental claims

Indiana's prompt-pay law covers dental claims. Clean claims must be paid or denied within 30 days electronic, 45 days paper; what late payment costs is set out below.

Ind. Code §27-8-5.7-6; §27-13-36.2-4

Read the statute text

Payment deadlines

Electronic claims: 30 days (electronic)
Paper claims: 45 days (paper)

Clean claims must be paid or denied within 30 days when filed electronically and 45 days on paper. The deadlines and the accrual dates are identical for insurers (IC 27-8-5.7-6) and HMOs (IC 27-13-36.2-4); the interest base is not. Insurers pay interest on the policy allowable amount; HMOs pay on the lesser of the usual, customary and reasonable charge or the amount agreed with the provider. Deficiency notices must go out within the same windows, and a payer that fails to send one establishes the submitted claim as clean.

Interest and penalties

Interest accrues from day 31 (electronic) or day 46 (paper) until the claim is paid. The annual rate is not in the clean-claim chapter: IC 27-8-5.7-6(d) borrows it from IC 12-15-21-3(7)(A), which sets the percentage, rounded to the nearest whole number, equal to the average investment yield on state general fund money for the state's previous fiscal year, excluding pension fund investments, as published in the State Comptroller's Annual Comprehensive Financial Report. IDOI announces the rate; the ACFR fixes it. IDOI Bulletin 248 set 1% for calendar year 2019 and IDOI has published no clean-claim rate bulletin since — that figure is the last announcement, not standing law, and must not be carried forward. Confirm the current year's rate with IDOI rather than computing one. The base differs by track: the policy allowable amount for insurers, and the lesser of UCR or the agreed amount for HMOs. The compliance penalties are separate, banded, and discretionary — the commissioner may assess up to $10,000 where the payer paid at least 85% but under 95% of clean claims on time, $10,000 to $100,000 at least 60% but under 85%, and $100,000 to $200,000 under 60% (IC 27-8-5.7-8(a); identical for HMOs at IC 27-13-36.2-6(a)). The penalty is aggregate, annual, and contestable under IC 4-21.5.

Does it apply to dental? Dental expressly covered

Covered on both tracks, but not because the chapter says so: the clean-claim chapter contains no definition of "provider" at all, and the word "dental" appears in it only in the permitted-forms list. That list is the direct proof — IC 27-8-5.7-7(3) and IC 27-13-36.2-5(3) name the American Dental Association claim form as a permitted format, and a chapter that authorises the ADA form plainly reaches dental claims. The provider route is a two-step cross-reference out of the chapter: IC 27-8-5.7-4 adopts IC 27-8-11-1(h), whose "health care services" at (c)(2) "includes hospital, medical, surgical, dental, vision, and pharmaceutical services or products." Dental-only HMOs come in through IC 27-13-36.2-2(2) → IC 27-13-34-3(a)(1) and -4(a), where "limited health services" starts with dental care services. Nothing in either chapter excepts stand-alone or limited-scope dental.

Self-funded (ERISA) plans: A self-funded private-employer (ERISA) dental plan is generally beyond a state prompt-pay statute's reach: 29 U.S.C. § 1144(b)(2)(B) bars a state from deeming such a plan an insurer, and the courts have read that to keep state insurance regulation off it. The statute itself never uses the words self-funded or prompt pay, and the rule is not categorical — a self-funded governmental or church plan is not an ERISA plan at all, so state law can reach it; § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law; and nothing in § 1144 addresses state enforcement against the third-party administrator or the network contract. Where the plan is a self-funded ERISA group health plan, the federal claims-procedure deadlines apply instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.

Estimate the late-payment interest

Uses the verified Indiana rule (Ind. Code §27-8-5.7-6; §27-13-36.2-4). Estimate only — the statute's own accrual triggers control.

How the claim was submitted

Indiana sets a different deadline for each, so this decides which day the field below counts from.

Electronic— 30 days (electronic)Paper— 45 days (paper)

Claim amount (allowed)Interest statutes run on the payable claim amount, not billed charges.Days past the deadlineDays after the statutory deadline for a electronic claim (30 days (electronic)), not days since submission.

No published rate to apply

Indiana's rate resets each year under IC 12-15-21-3(7)(A): the percentage, rounded to the nearest whole number, equal to the average investment yield on state general fund money for the state's previous fiscal year, excluding pension fund investments, as published in the State Comptroller's Annual Comprehensive Financial Report. IDOI announces the rate; the ACFR fixes it. IDOI's last rate bulletin, Bulletin 248, set 1% only for calendar year 2019. Confirm the current year's rate with IDOI before relying on any figure.

How we calculate this

The calculator does not show a payable amount for this result; the explanation above states the controlling limitation. The rate and deadline come from Ind. Code §27-8-5.7-6; §27-13-36.2-4, read against the statute text linked in the sources on this page (last verified 2026-08-31). Accrual start dates, clean-claim status, safe harbors, and plan funding all affect the real figure — treat this as an estimate for the payer conversation, not a demandable amount.

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Also in the statute

The "issued in Indiana" limit is an insurer-track limit only: IC 27-8-5.7-2 defines a clean claim as one submitted under "an accident and sickness insurance policy issued in Indiana." The HMO chapter has no parallel words — IC 27-13-36.2-1 defines a clean claim as one "for payment for health care services provided to an enrollee."
Interest runs to "the provider that submitted the claim" (IC 27-8-5.7-6(b)); the penalty is assessed by the commissioner, not recovered by a patient, and neither chapter creates a private right of action on its face.
Nothing in either chapter confines the clock to participating providers, and the only contract-override clause in ch. 5.7 is §10(f) — it reaches an insurer and a hospital licensed under IC 16-21, covers only the recoupment and audit timeframes in §10, and cannot vary §6 or touch a dental practice.

Sources (statute text)